H.—3l

of 1917-1918 (1917, 5,458 ; 1918, 5,539). In 1932 notifications for the first time since 1913 dropped to under 1,000 and have since remained below that figure, dropping to 367 in 1940, 383 in 1941, and 542 in 1942. It is interesting to note that since 1922 the percentage of the total cases in the Dominion occurring in the South Island has been lower than the percentage of total population of the Dominion living in that Island. Since 1933 the difference has been marked ; on only one occasion (1939) has the percentage of cases occurring in the South Island been 10 per cent., and in 1938 it was as low as 4 per cent. During this period the percentage of the total population living in the South Island has been approximately 37 per cent. That this difference in incidence is not associated with differing age-constitutions of the populations of the two islands is indicated by the fact that the percentage of the total population under fifteen years of age living in the South Island was, at the census of 1936, also 37 per cent. The Department is continuing steadily with its campaign of immunization. This method of protection has stood the test of time, and there is now world-wide agreement as to its efficacy and safety. In the East Coast Health District and in other parts of the Dominion immunization has been carried out with encouraging results. During the year, 14,917 children attended for voluntary immunization by the School Medical Service, and of these, 12,968 finished the complete course. However, until at least three-quarters of the child population under six years of age have been immunized no substantial improvement in the incidence and death-rate can be expected throughout the Dominion. The present tendency towards increase in the number of notifications emphasizes the need for the fullest co-operation by the general public with the Department in its efforts to stamp out this preventable disease with its deadly effect on young life. Influenza.—lnfluenza was widespread in 1942 among both the armed forces and the civilian population. It was of the so-called " seasonal " type, which is apt to become epidemic during the winter months. Lethargic Encephalitis. —Five cases of this disease were notified in 1942. Poliomyelitis. —Thirty cases were notified, in comparison with 4 in 1941. Cerebrospinal Fever. —This disease has been notifiable in New Zealand since 1907, but first came into prominence during the 1914-18 war. In the period 1915-1919, 517 cases were notified. Thereafter the incidence of the disease gradually declined until in 1935 only 12 (10 European, 2 Maori) cases were notified. Since then the yearly European and Maori notifications have been : — Year. European. Maori. Year. European. Maori. 1936 .. .. 12 4 1940 .. .. 19 1 1937 .. .. 13 5 1941 .. .. 163 47 1938 .. .. 24 2 1942 .. .. 852 80 1939 .. .. 22 3 The epidemic of 1942 was the greatest New Zealand has had. The total number of cases was 932 (European 852, Maori 80), while the deaths were 117 (European 111, Maori 6), giving case-mortality rates of 13 per cent, and 7'5 per cent, respectively, or a rate of 12-6 without distinction of race. A comparison may be made with the epidemic in England and Wales in 1940 and 1941 : — England and Wales — In 1940 there were 12,771 notifications, with 2,584 deaths. Incidence : 0-31 per 1,000 mean population. Case-fatality rate, 20 per cent. In 1941 there were 11,077 notifications, with 2,163 deaths. Incidence : 0'27 per 1,000 mean population. Case-fatality rate 19-5. New Zealand— In 1942 there were 932 notifications, with 117 deaths. Incidence : 0-57 per 1,000 of mean population. Case-fatality rate, 12-6 per cent. The introduction of sulphapyradine and allied drugs has robbed this disease of much of its former terror. Whooping-cough and Measles.—There were 4 deaths from whooping-cough and 31 from measles. Puerperal Sepsis. —Sepsis following childbirth was responsible for 15 deaths. Sepsis following abortion, on the other hand, caused 27 deaths. Tuberculosis.—Deaths from tuberculosis (all forms) were 607, as compared with 597 in 1941. The death-rate per 10,000 mean population for respiratory, non-respiratory, and all forms of tuberculosis is set out in the following table : —

A more active campaign against tuberculosis is foreshadowed by the setting-up of a special Division dealing with this disease and by the appointment of Dr. C. -A. Taylor as the Director of the Division. In the development of a more active campaign against tuberculosis matters which require consideration are as follows : — (1) Housing and Economic Conditions : It is recognized that unsatisfactory housing and economic conditions are powerful factors in the cause and spread of tuberculosis. The housing of Maori tuberculous cases is partly provided for by the hutment scheme as mentioned in previous reports, but under present conditions there is difficulty in supplying sufficient hutments to meet requirements. (2) Late Diagnosis : Far too many cases are still brought for treatment in an advanced state. As a part of its programme of case-finding the Department has encouraged Hospital Boards to establish miniature radiographic machines. Ten of these units are now operating in the North Island and three in the South. The shortage of efficiently-trained radiographers has delayed the complete operation of these units, but it is hoped shortly to initiate steps for the training of a sufficient number of radiographers.

2

Respiratory Non-respiratory Tuberculosis Year ' Tuberculosis. Tuberculosis. (all Forms). ]940 .. .. 3-24 0-64 3-88 1941 .. .. 3-19 0-69 3-88 1942 .. .. 3-18 0-75 3-93